Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 094041 | GA |
Y | 2080P0202X | Pediatric Cardiologist | 076296 | GA |
NPI | 1073756631 |
---|---|
Provider Name | Holly Bauser-Heaton |
First Address | Atlanta, GA 30341-5540 |
Second Address | Atlanta, GA 30322-1060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2009 |
Last Update Date | 25/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003177562B | (05) | GA |